Materiały źródłowe

• #1 How do healthcare providers diagnose POI? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/poi/conditioninfo/diagnosed

  The key signs of POI are: […] If a woman is younger than age 40 and begins having irregular periods or stops having periods for 4 months or longer, her healthcare provider may take these steps to diagnose the problem: […] Do a pregnancy test. This test will rule out an unexpected pregnancy as the reason for missed periods. […] Do a physical exam. During the physical exam, the healthcare provider looks for signs of other disorders. In some cases, the presence of these other disorders will rule out POI. Or, if the other disorders are associated with POI, such as Addison’s disease, a healthcare provider will know that POI may be present. […] Collect blood. The healthcare provider will collect your blood and send it to a lab, where a technician will run several tests, including: […] Follicle-Stimulating Hormone (FSH) test. FSH signals the ovaries to make estrogen, sometimes called the „female hormone” because women need high levels of it for fertility and overall health. If the ovaries are not working properly, as is the case in POI, the level of FSH in the blood increases. The healthcare provider may do two FSH tests, at least a month apart. If the FSH level in both tests is as high as it is in women who have gone through menopause, then POI is likely.

• #1 How do healthcare providers diagnose POI? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/poi/conditioninfo/diagnosed

  The healthcare provider will also ask questions about a woman’s medical history. He or she may ask about: […] If they do not do tests to rule out POI, some healthcare providers might assume missed periods are related to stress. However, this approach is problematic because it will lead to a delay in diagnosis; further evaluation is needed.

• #1 Primary Ovarian Insufficiency in Adolescents and Young Women | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/07/primary-ovarian-insufficiency-in-adolescents-and-young-women

  Diagnosis of primary ovarian insufficiency includes menstrual irregularity for at least 3 consecutive months, follicle-stimulating hormone and estradiol levels (two random tests at least 1 month apart), and prolactin and thyroid function test. […] If gonadotropins are elevated into the menopausal range (typically, basal FSH levels will be greater than 30-40 mIU/mL, depending on the laboratory used), a repeat FSH measurement is indicated in 1 month. […] If the result indicates that FSH is elevated, a diagnosis of primary ovarian insufficiency can be established. […] Once a diagnosis of primary ovarian insufficiency is established, further testing, including karyotype, adrenal antibodies, FMR1 premutation, and pelvic ultrasonography, may be indicated to investigate possible etiologies of primary ovarian insufficiency.

• #1 How do healthcare providers diagnose POI? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/poi/conditioninfo/diagnosed

  Luteinizing hormone (LH) test. LH signals a mature follicle to release an egg. Women with POI have high LH levels, more evidence that the follicles are not functioning normally. […] Estrogen test. In women with POI, estrogen levels are usually low, because the ovaries are not functioning properly in their role as estrogen producers. […] Karyotype test. This test looks at all 46 of your chromosomes to check for abnormalities. The karyotype test could reveal genetic changes in the structure of chromosomes that might be associated with POI and other health problems. […] Do a pelvic ultrasound. In this test, the healthcare provider uses a sound wave (sonogram) machine to create and view pictures of the inside of a woman’s pelvic area. A sonogram can show whether or not the ovaries are enlarged or have multiple follicles.

• #1 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  The guideline group recommends that HCPs consider these points when diagnosing POI: Pregnancy should be excluded in women presenting with amenorrhea. […] The guideline group does not recommend diagnosing POI based on serum estradiol concentrations. […] Anti-Mullerian hormone (AMH) should not be used as the primary diagnostic test for POI. […] The guideline group recommends that AMH testing may be useful to confirm POI diagnosis where FSH results are inconclusive, but AMH results need to be interpreted within the clinical context. […] The guideline group recommends that HCPs do not routinely perform AMH testing to predict POI due to insufficient evidence of accuracy. […] The guideline group recommends that HCPs inform women with POI of the different causes of POI, the limitations of current knowledge and testing for causes of POI, and that an exact cause may not be identified.

• #1 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  Study Question: How should premature/primary ovarian insufficiency (POI) be diagnosed and managed, based on the best available evidence from published literature? […] The current guideline provides 145 recommendations on symptoms, diagnosis, causation, sequelae and treatment of POI. […] The guideline aims to help health care professionals to apply best practice care for women with POI. […] The recent update of the POI guideline covers 40 clinical questions on diagnosis of the condition, the different sequelae, including bone, cardiovascular, neurological and sexual function, fertility and general well-being, and treatment options, including hormone therapy. […] Significant changes from the previous 2015 guideline include the recommendations that only one elevated FSH25 IU is required for diagnosis of POI and guidance that AMH testing, repeat FSH measurement and/or AMH may be required where there is diagnostic uncertainty.

• #1 Primary Ovarian Insufficiency in Adolescents and Young Women | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/07/primary-ovarian-insufficiency-in-adolescents-and-young-women

  ABSTRACT: Primary ovarian insufficiency is the depletion or dysfunction of ovarian follicles with cessation of menses before age 40 years. […] There is no consensus on criteria to identify primary ovarian insufficiency in adolescents, and delay in diagnosis is common. […] Although some adolescent females will report hot flushes or vaginal symptoms like dryness or dyspareunia, the most common presenting symptom of primary ovarian insufficiency is primary or secondary amenorrhea. […] Among patients with amenorrhea, the incidence of primary ovarian insufficiency ranges from 2% to 10%. […] Because irregular menstrual cycles are both common during early adolescence and an initial symptom of early primary ovarian insufficiency, diagnosis can be difficult in this population. […] Therefore, in young females it is important to evaluate amenorrhea or a change from regular to irregular menses for 3 or more consecutive months in the absence of hormonal preparations such as oral contraceptives (OCs) for all potential causes, including pregnancy, polycystic ovary syndrome, hypothalamic amenorrhea, thyroid abnormalities, hyperprolactinemia, and primary ovarian insufficiency.

• #1 Hormone Therapy in Primary Ovarian Insufficiency | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/05/hormone-therapy-in-primary-ovarian-insufficiency

  Primary ovarian insufficiency describes a spectrum of declining ovarian function and reduced fecundity due to a premature decrease in initial follicle number, an increase in follicle destruction, or poor follicular response to gonadotropins. […] In women with primary ovarian insufficiency, systemic hormone therapy (HT) is an effective approach to treat the symptoms of hypoestrogenism and mitigate long-term health risks if there are no contraindications to treatment. […] Hormone therapy is indicated to reduce the risk of osteoporosis, cardiovascular disease, and urogenital atrophy and to improve the quality of life of women with primary ovarian insufficiency. […] As a first-line approach, HT (either orally or transdermally) that achieves replacement levels of estrogen is recommended. […] Treatment for all women with primary ovarian insufficiency should continue until the average age of natural menopause is reached (age 5051 years).

• #1 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  The guideline group recommends that HCPs discuss the risk of POI as part of the consent process before a medical or surgical intervention that may cause POI. […] The guideline group recommends that HCPs discuss the implications of genetic testing before the test is performed. […] Chromosomal analysis testing is recommended for all women with non-iatrogenic POI. […] The guideline group recommends that HCPs do not routinely perform thyroid peroxidase (TPO) antibody screening as part of testing for autoimmune causes of POI due to the high prevalence of positive TPO antibodies in the general community. […] The guideline group recommends that HCPs convey the diagnosis of POI in a compassionate and sensitive manner, provide personalised evidence-based information about the condition, and ensure time for the women to ask questions.

• #1 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  The guideline group recommends that health care professionals (HCPs) enquire about symptoms of estrogen deficiency in women presenting with irregular menstrual cycles or amenorrhea. […] The guideline group recommends HCPs consider and exclude the diagnosis of POI in women aged less than 40 years who have amenorrhea/ irregular menstrual cycles or estrogen-deficiency symptoms. […] HCPs should diagnose POI based on the presence of spontaneous amenorrhea or irregular menstrual cycles and biochemical confirmation. […] The guideline group recommends the following diagnostic criteria: disordered menstrual cycles (spontaneous amenorrhea or irregular menstrual cycles) for at least 4 months, and an elevated follicle stimulating hormone (FSH) concentration25 IU/l. […] FSH assessment should be repeated after 4-6 weeks if there is diagnostic uncertainty.

• #1 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  The guideline group recommends shared decision making and support for continuity of care in managing POI. […] The guideline group recommends referral of women with POI to appropriate support groups and mental health care. […] The guideline group recommends that women with POI should be informed that POI without HT is associated with reduced life expectancy, largely due to cardiovascular disease. […] HT is recommended for women with POI until the usual age of menopause for primary prevention to reduce the risk of morbidity and mortality, whether there are estrogen deficiency symptoms or not. […] The guideline group recommends that women with POI should be encouraged to adopt a healthy lifestyle (including avoiding smoking, having a healthy diet and regular physical activity, and maintaining a healthy weight range) to reduce cardiovascular risk.

• #2 Primary Ovarian Insufficiency in Adolescents and Young Women | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/07/primary-ovarian-insufficiency-in-adolescents-and-young-women

  ABSTRACT: Primary ovarian insufficiency is the depletion or dysfunction of ovarian follicles with cessation of menses before age 40 years. […] There is no consensus on criteria to identify primary ovarian insufficiency in adolescents, and delay in diagnosis is common. […] Although some adolescent females will report hot flushes or vaginal symptoms like dryness or dyspareunia, the most common presenting symptom of primary ovarian insufficiency is primary or secondary amenorrhea. […] Among patients with amenorrhea, the incidence of primary ovarian insufficiency ranges from 2% to 10%. […] Because irregular menstrual cycles are both common during early adolescence and an initial symptom of early primary ovarian insufficiency, diagnosis can be difficult in this population. […] Therefore, in young females it is important to evaluate amenorrhea or a change from regular to irregular menses for 3 or more consecutive months in the absence of hormonal preparations such as oral contraceptives (OCs) for all potential causes, including pregnancy, polycystic ovary syndrome, hypothalamic amenorrhea, thyroid abnormalities, hyperprolactinemia, and primary ovarian insufficiency.

• #2 Ovarian Insufficiency Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/271046-workup

  Three groups of tests should be performed when ovarian failure is suspected or has been diagnosed. They include tests that establish the diagnosis of POI/POF, tests that help clarify the etiology, and screening tests for other diseases known to have higher prevalence among women with POI/POF. […] A pregnancy test (urine or beta human chorionic gonadotropin [bhCG] in the blood) should be the first study performed in every woman of reproductive age who presents with amenorrhea. […] Measuring serum FSH level is the core study to establish the diagnosis of POI/POF after pregnancy has been ruled out. By convention, 2 FSH levels in the menopausal range for the specific assay (40 IU/mL by radioimmunoassay), measured at least 1 month apart, are diagnostic of POI/POF. […] Measurement of serum LH is also important. In most cases of spontaneous POI/POF, FSH is higher than LH. If autoimmune oophoritis is present, FSH may be only mildly elevated, sometimes below the cutoff of 40 IU/mL, while LH is markedly elevated.

• #2 Primary Ovarian Insufficiency: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17963-primary-ovarian-insufficiency

  Primary ovarian insufficiency (POI) is a condition that occurs when your ovaries fail earlier than average. […] Providers diagnose POI if you’re younger than 40 and: […] Your healthcare provider will perform a physical exam and a pelvic exam. They’ll also ask you about your health history. Knowing about your typical menstrual cycle, previous pregnancies or use of birth control is helpful to your provider in diagnosing POI. […] Next, they will likely order blood tests to measure levels of certain hormones in your body. These include follicle stimulating hormone (FSH), estrogen and prolactin. […] Healthcare providers treat POI in different ways. It depends on your age, symptoms and if you wish to get pregnant. Primary ovarian insufficiency treatment involves: […] Hormone therapy gives your body the hormones that your ovaries aren’t making. Hormone therapy may involve taking just estrogen or taking estrogen and progesterone. […] Providers may use these terms interchangeably to describe menopause before 40. […] Yes, there’s still a chance that a woman with POI can get pregnant. If you have POI and want to get pregnant, your pregnancy care provider can advise you on your options.

• #2 Primary Ovarian Insufficiency | POI | MedlinePlus

  https://medlineplus.gov/primaryovarianinsufficiency.html

  Primary ovarian insufficiency (POI) is diagnosed through a medical history, pregnancy test, physical exam, blood tests to check hormone levels, and a pelvic ultrasound to assess the ovaries. […] To diagnose POI, your health care provider may do: A medical history, including asking whether you have relatives with POI; A pregnancy test, to make sure that you are not pregnant; A physical exam, to look for signs of other disorders that could be causing your symptoms; Blood tests, to check for certain hormone levels. You may also have a blood test to do a chromosome analysis. A chromosome is the part of a cell that contains genetic information; A pelvic ultrasound, to see whether or not the ovaries are enlarged or have multiple follicles.

• #2 Primary Ovarian Insufficiency in Adolescents and Young Women | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/07/primary-ovarian-insufficiency-in-adolescents-and-young-women

  Diagnosis of primary ovarian insufficiency includes menstrual irregularity for at least 3 consecutive months, follicle-stimulating hormone and estradiol levels (two random tests at least 1 month apart), and prolactin and thyroid function test. […] If gonadotropins are elevated into the menopausal range (typically, basal FSH levels will be greater than 30-40 mIU/mL, depending on the laboratory used), a repeat FSH measurement is indicated in 1 month. […] If the result indicates that FSH is elevated, a diagnosis of primary ovarian insufficiency can be established. […] Once a diagnosis of primary ovarian insufficiency is established, further testing, including karyotype, adrenal antibodies, FMR1 premutation, and pelvic ultrasonography, may be indicated to investigate possible etiologies of primary ovarian insufficiency.

• #2 How do healthcare providers diagnose POI? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/poi/conditioninfo/diagnosed

  Luteinizing hormone (LH) test. LH signals a mature follicle to release an egg. Women with POI have high LH levels, more evidence that the follicles are not functioning normally. […] Estrogen test. In women with POI, estrogen levels are usually low, because the ovaries are not functioning properly in their role as estrogen producers. […] Karyotype test. This test looks at all 46 of your chromosomes to check for abnormalities. The karyotype test could reveal genetic changes in the structure of chromosomes that might be associated with POI and other health problems. […] Do a pelvic ultrasound. In this test, the healthcare provider uses a sound wave (sonogram) machine to create and view pictures of the inside of a woman’s pelvic area. A sonogram can show whether or not the ovaries are enlarged or have multiple follicles.

• #2 Ovarian Insufficiency Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/271046-workup

  A parallel test of serum estradiol is necessary. As a rule, serum estradiol is low in women with POI/POF and is similar to or less than the early follicular phase estradiol of women who cycle normally. The combination of low estradiol and high gonadotropins defines POI/POF. […] Occasionally, women with POI/POF may have spontaneous follicular activity, and, if hormonal tests are performed during such episodes, levels of FSH, LH, and estradiol could be in the normal range or FSH and LH could be elevated only minimally (below the menopausal range). This may lead to an erroneous rejection of the diagnosis of POI/POF. In these cases, persistent amenorrhea or oligomenorrhea accompanied by menopausal symptoms necessitates a repeat of the above tests in 1-2 months. […] A karyotype should be performed as a part of the routine evaluation after the diagnosis of POI/POF is established. […] Ovarian ultrasonography can be useful in the workup of patients with POI/POF as it will identify those women with multifollicular ovaries and suggest the diagnosis of either autoimmune oophoritis or 17-20 desmolase deficiency.

• #2 Premature ovarian insufficiency – British Menopause Society

  https://thebms.org.uk/publications/consensus-statements/premature-ovarian-insufficiency/

  Diagnosis of POI should be based on a combination of oligomenorrhoea / amenorrhoea of more than 4 months’ duration associated with elevated gonadotropins (FSH >40 iu/l) on at least two occasions measured 4-6 weeks apart in women under the age of 40. […] AMH should not be routinely used to diagnose POI, but may have a role when the diagnosis of POI is inconclusive. […] Assessment of bone mineral density should be considered at the time of diagnosis of POI. […] Further research is required to assess the optimal regimen, dose or route of administration of hormone replacement in women with POI.

• #2

  https://bpac.org.nz/2019/ovarian.aspx

  Primary ovarian insufficiency can be diagnosed in women aged 40 years with four to six months of amenorrhoea (after excluding other causes) and two FSH tests 40 IU/L, at least four weeks apart. […] A diagnosis of primary ovarian insufficiency can be made on the basis of four to six months of amenorrhoea in women aged 40 years after excluding other causes of secondary amenorrhoea, and two FSH tests 40 IU/L, conducted four to six weeks apart. […] Oestradiol levels should be measured to support the FSH results. […] Hormone treatment until at least the age of natural menopause is recommended. […] Hormone treatment, either with MHT or a COC, is recommended for women with primary ovarian insufficiency (unless there are contraindications) to alleviate symptoms, improve their quality of life, and reduce the long-term risks of oestrogen deficiency. […] Women with primary ovarian insufficiency should be reviewed at least annually, including an assessment of symptom control, adherence to treatment and cardiovascular risk.

• #2 Recommendations Updated on Diagnosis, Management of Premature/Primary Ovarian Insufficiency

  https://www.endocrinologyadvisor.com/news/recommendations-updated-on-diagnosis-management-of-premature-primary-ovarian-insufficiency/

  Significant changes from previous guideline include recommendation that only FSH 25 IU required for POI diagnosis. […] The updated guidelines included 145 recommendations. […] Significant changes from the previous guideline include the recommendation that only follicle stimulating hormone (FSH) 25 IU is required for POI diagnosis and guidance that AMH testing, repeat FSH measurement, and/or AMH may be necessary in cases of diagnostic uncertainty. […] The guideline group concluded that there is still an urgent need for more research on the most appropriate diagnostic and treatment options.

• #2 Premature ovarian insufficiency in general practice: Meeting the needs of women

  https://www.racgp.org.au/afp/2017/june/premature-ovarian-insufficiency-in-general-practic

  In a study of Australian women with POI, diagnosis took longer than two years in 23% of women, with at least two clinicians consulted on average. […] Diagnosis of POI requires FSH levels in the menopausal range on two occasions at least four to six weeks apart in a woman aged 40 years after more than four months of amenorrhoea or menstrual irregularity, and after secondary causes of amenorrhoea have been excluded. […] The routine use of anti-Mllerian hormone levels in the diagnosis of POI is not currently recommended as its accuracy is not validated in this setting. […] Following diagnosis, the aetiology of POI and long-term consequences should be evaluated, and specialist referral may be necessary. […] The diagnosis of POI can be extremely distressing for women. […] The diagnosis of POI is often challenging for health practitioners, and traumatic for affected women.

• #2 Hormone Therapy in Primary Ovarian Insufficiency | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/05/hormone-therapy-in-primary-ovarian-insufficiency

  Detailed information regarding the workup, causes, and diagnosis of primary ovarian insufficiency is reviewed in Committee Opinion No. 605, Primary Ovarian Insufficiency in Adolescents and Young Women. […] Overt ovarian insufficiency refers to women younger than 40 years who have elevated follicle-stimulating hormone levels in the menopausal range (at least 3040 mIU/mL) and amenorrhea. […] The term primary ovarian insufficiency more accurately captures the nature of ovarian dysfunction displayed in affected women, 50% of whom experience infrequent ovulation and menstrual cycles after diagnosis and 510% of whom may achieve spontaneous pregnancies. […] Regardless of the underlying cause of primary ovarian insufficiency, the consequences of ovarian dysfunction and hypoestrogenism can be dire for affected individuals. […] The focus of this Committee Opinion is to review the medical and psychosocial risks facing women with primary ovarian insufficiency and to discuss the various HT treatment options available.

• #2 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  The guideline group recommends shared decision making and support for continuity of care in managing POI. […] The guideline group recommends referral of women with POI to appropriate support groups and mental health care. […] The guideline group recommends that women with POI should be informed that POI without HT is associated with reduced life expectancy, largely due to cardiovascular disease. […] HT is recommended for women with POI until the usual age of menopause for primary prevention to reduce the risk of morbidity and mortality, whether there are estrogen deficiency symptoms or not. […] The guideline group recommends that women with POI should be encouraged to adopt a healthy lifestyle (including avoiding smoking, having a healthy diet and regular physical activity, and maintaining a healthy weight range) to reduce cardiovascular risk.

• #2 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  The guideline group recommends that health care professionals (HCPs) enquire about symptoms of estrogen deficiency in women presenting with irregular menstrual cycles or amenorrhea. […] The guideline group recommends HCPs consider and exclude the diagnosis of POI in women aged less than 40 years who have amenorrhea/ irregular menstrual cycles or estrogen-deficiency symptoms. […] HCPs should diagnose POI based on the presence of spontaneous amenorrhea or irregular menstrual cycles and biochemical confirmation. […] The guideline group recommends the following diagnostic criteria: disordered menstrual cycles (spontaneous amenorrhea or irregular menstrual cycles) for at least 4 months, and an elevated follicle stimulating hormone (FSH) concentration25 IU/l. […] FSH assessment should be repeated after 4-6 weeks if there is diagnostic uncertainty.

• #2 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  The guideline group recommends that HCPs consider these points when diagnosing POI: Pregnancy should be excluded in women presenting with amenorrhea. […] The guideline group does not recommend diagnosing POI based on serum estradiol concentrations. […] Anti-Mullerian hormone (AMH) should not be used as the primary diagnostic test for POI. […] The guideline group recommends that AMH testing may be useful to confirm POI diagnosis where FSH results are inconclusive, but AMH results need to be interpreted within the clinical context. […] The guideline group recommends that HCPs do not routinely perform AMH testing to predict POI due to insufficient evidence of accuracy. […] The guideline group recommends that HCPs inform women with POI of the different causes of POI, the limitations of current knowledge and testing for causes of POI, and that an exact cause may not be identified.

• #2 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  Women with POI should be informed that POI substantially reduces the chances of natural conception. […] Women with non-surgical POI should be informed that ovarian activity may occur. […] Women with POI should be informed that there are no interventions that have been reliably shown to increase ovarian activity and natural conception rates. […] Women with POI should be informed that oocyte donation is an established option to achieve pregnancy after a diagnosis of POI. […] Women with POI should be informed that there is limited evidence for androgen treatment for indications other than hypoactive sexual desire disorder, and that long-term health effects are unknown. […] The guideline group recommends that women with POI should have a regular clinical review, addressing individualised risk factors and adherence to therapy.

• #3 Primary Ovarian Insufficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK589674/

  Primary ovarian insufficiency (POI) is a disease that affects women less than 40 years of age. Commonly, women present with amenorrhea for 4-6 months, low estradiol levels, and elevated follicle-stimulating hormone (FSH) level. This article outlines the evaluation, diagnosis, treatment, and management of primary ovarian insufficiency. […] The typical onset of POI is in women less than 40 years of age and is diagnosed in the setting of amenorrhea lasting 4-6 months in combination with elevated follicle-stimulating hormone (FSH) and decreased estradiol levels obtained one month apart. […] In the setting of secondary amenorrhea, first and foremost a pregnancy test must be completed to exclude pregnancy. Following a negative pregnancy test, it is appropriate to evaluate for any chronic medical conditions that affect the overall health of the patient (eg. uncontrolled diabetes, heart disease) as well as evaluation for any evidence of hypothalamic-pituitary axis depression in situations of extreme physical activity levels, depression, or anorexia.

• #3 Primary Ovarian Insufficiency: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17963-primary-ovarian-insufficiency

  Primary ovarian insufficiency (POI) is a condition that occurs when your ovaries fail earlier than average. […] Providers diagnose POI if you’re younger than 40 and: […] Your healthcare provider will perform a physical exam and a pelvic exam. They’ll also ask you about your health history. Knowing about your typical menstrual cycle, previous pregnancies or use of birth control is helpful to your provider in diagnosing POI. […] Next, they will likely order blood tests to measure levels of certain hormones in your body. These include follicle stimulating hormone (FSH), estrogen and prolactin. […] Healthcare providers treat POI in different ways. It depends on your age, symptoms and if you wish to get pregnant. Primary ovarian insufficiency treatment involves: […] Hormone therapy gives your body the hormones that your ovaries aren’t making. Hormone therapy may involve taking just estrogen or taking estrogen and progesterone. […] Providers may use these terms interchangeably to describe menopause before 40. […] Yes, there’s still a chance that a woman with POI can get pregnant. If you have POI and want to get pregnant, your pregnancy care provider can advise you on your options.

• #3

  https://bpac.org.nz/2019/ovarian.aspx

  Primary ovarian insufficiency can be diagnosed in women aged 40 years with four to six months of amenorrhoea (after excluding other causes) and two FSH tests 40 IU/L, at least four weeks apart. […] A diagnosis of primary ovarian insufficiency can be made on the basis of four to six months of amenorrhoea in women aged 40 years after excluding other causes of secondary amenorrhoea, and two FSH tests 40 IU/L, conducted four to six weeks apart. […] Oestradiol levels should be measured to support the FSH results. […] Hormone treatment until at least the age of natural menopause is recommended. […] Hormone treatment, either with MHT or a COC, is recommended for women with primary ovarian insufficiency (unless there are contraindications) to alleviate symptoms, improve their quality of life, and reduce the long-term risks of oestrogen deficiency. […] Women with primary ovarian insufficiency should be reviewed at least annually, including an assessment of symptom control, adherence to treatment and cardiovascular risk.

• #3 Primary Ovarian Insufficiency – Symptoms, Causes, Diagnosis and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/primary-ovarian-insufficiency

  Primary ovarian insufficiency (POI) is a disorder in which the ovaries stop functioning properly in adults under the age of 40. […] If you are under the age of 40 and have not had a regular period for three months or more, consult a health care practitioner for relevant health examination. […] To identify the reason of your irregular, missed, or abnormally light menstrual cycles, the following information should be inquired. […] In addition to asking you detailed questions about your personal and family history and performing a physical examination, your physician should order a blood test to evaluate your hormone levels. […] For a diagnosis of POI, increased levels of the hormone follicle-stimulating hormone are required (FSH). […] If blood testing indicate that you have POI, your doctor should investigate for possible causes; karyotyping, which examines whether chromosomal abnormalities exist; testing for antibodies against the adrenal gland, which determines whether you have a particular form of ovarian autoimmunity.

• #3 Ovarian Insufficiency Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/271046-workup

  Three groups of tests should be performed when ovarian failure is suspected or has been diagnosed. They include tests that establish the diagnosis of POI/POF, tests that help clarify the etiology, and screening tests for other diseases known to have higher prevalence among women with POI/POF. […] A pregnancy test (urine or beta human chorionic gonadotropin [bhCG] in the blood) should be the first study performed in every woman of reproductive age who presents with amenorrhea. […] Measuring serum FSH level is the core study to establish the diagnosis of POI/POF after pregnancy has been ruled out. By convention, 2 FSH levels in the menopausal range for the specific assay (40 IU/mL by radioimmunoassay), measured at least 1 month apart, are diagnostic of POI/POF. […] Measurement of serum LH is also important. In most cases of spontaneous POI/POF, FSH is higher than LH. If autoimmune oophoritis is present, FSH may be only mildly elevated, sometimes below the cutoff of 40 IU/mL, while LH is markedly elevated.

• #3 Primary Ovarian Insufficiency in Adolescents and Young Women | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/07/primary-ovarian-insufficiency-in-adolescents-and-young-women

  Diagnosis of primary ovarian insufficiency includes menstrual irregularity for at least 3 consecutive months, follicle-stimulating hormone and estradiol levels (two random tests at least 1 month apart), and prolactin and thyroid function test. […] If gonadotropins are elevated into the menopausal range (typically, basal FSH levels will be greater than 30-40 mIU/mL, depending on the laboratory used), a repeat FSH measurement is indicated in 1 month. […] If the result indicates that FSH is elevated, a diagnosis of primary ovarian insufficiency can be established. […] Once a diagnosis of primary ovarian insufficiency is established, further testing, including karyotype, adrenal antibodies, FMR1 premutation, and pelvic ultrasonography, may be indicated to investigate possible etiologies of primary ovarian insufficiency.

• #3 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  The guideline group recommends that HCPs consider these points when diagnosing POI: Pregnancy should be excluded in women presenting with amenorrhea. […] The guideline group does not recommend diagnosing POI based on serum estradiol concentrations. […] Anti-Mullerian hormone (AMH) should not be used as the primary diagnostic test for POI. […] The guideline group recommends that AMH testing may be useful to confirm POI diagnosis where FSH results are inconclusive, but AMH results need to be interpreted within the clinical context. […] The guideline group recommends that HCPs do not routinely perform AMH testing to predict POI due to insufficient evidence of accuracy. […] The guideline group recommends that HCPs inform women with POI of the different causes of POI, the limitations of current knowledge and testing for causes of POI, and that an exact cause may not be identified.

• #3 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  The guideline group recommends that HCPs discuss the risk of POI as part of the consent process before a medical or surgical intervention that may cause POI. […] The guideline group recommends that HCPs discuss the implications of genetic testing before the test is performed. […] Chromosomal analysis testing is recommended for all women with non-iatrogenic POI. […] The guideline group recommends that HCPs do not routinely perform thyroid peroxidase (TPO) antibody screening as part of testing for autoimmune causes of POI due to the high prevalence of positive TPO antibodies in the general community. […] The guideline group recommends that HCPs convey the diagnosis of POI in a compassionate and sensitive manner, provide personalised evidence-based information about the condition, and ensure time for the women to ask questions.

• #3 Primary Ovarian Insufficiency | POI | MedlinePlus

  https://medlineplus.gov/primaryovarianinsufficiency.html

  Primary ovarian insufficiency (POI) is diagnosed through a medical history, pregnancy test, physical exam, blood tests to check hormone levels, and a pelvic ultrasound to assess the ovaries. […] To diagnose POI, your health care provider may do: A medical history, including asking whether you have relatives with POI; A pregnancy test, to make sure that you are not pregnant; A physical exam, to look for signs of other disorders that could be causing your symptoms; Blood tests, to check for certain hormone levels. You may also have a blood test to do a chromosome analysis. A chromosome is the part of a cell that contains genetic information; A pelvic ultrasound, to see whether or not the ovaries are enlarged or have multiple follicles.

• #3 Understanding test results for Premature Ovarian Insufficiency

  https://www.daisynetwork.org/understanding-test-results-for-premature-ovarian-insufficiency/

  The remaining tests are specialist ones and are more likely to be performed by a hospital gynaecologist. […] Antibody test There are many causes of POI and it can occasionally be associated with an autoimmune disease (although the cause usually remains unknown or idiopathic). […] AMH AMH stands for anti-Mllerian hormone. This is a relatively new test. At the moment it is used to check a womans ovarian reserve but currently, it can only be interpreted if a woman does not have POI. […] Furthermore, and unfortunately, it cannot be used to predict POI. […] Karyotype and FMR1 gene test A karyotype test counts the number of chromosomes and also checks if any of the chromosomes are mixed up. The most common diagnosis that can be picked up on a karyotype test in POI is Turner syndrome. […] A genetic test can look for abnormalities in the FMR1 gene, which is associated with POI.

• #3 Recommendations Updated on Diagnosis, Management of Premature/Primary Ovarian Insufficiency – Clinical Advisor

  https://www.clinicaladvisor.com/news/diagnosis-management-of-premature-primary-ovarian-insufficiency/

  The researchers noted that there is still an urgent need for more research on the most appropriate diagnostic and treatment options for POI. […] In an evidence-based guideline issued by the Centre for Research Excellence in Womens Health in Reproductive Life and published online in Climacteric, updated recommendations are presented for the diagnosis and management of premature/primary ovarian insufficiency (POI). […] The updated guidelines included 145 recommendations. The list of clinical questions addressed in this guideline was expanded, including in relation to the role of anti-Mllerian hormone (AMH) in the diagnosis of POI and fertility preservation. […] Significant changes from the previous guideline include the recommendation that only follicle-stimulating hormone (FSH) 25 IU is required for POI diagnosis and guidance that AMH testing, repeat FSH measurement, and/or AMH may be necessary in cases of diagnostic uncertainty.

• #3 Premature ovarian insufficiency in general practice: Meeting the needs of women

  https://www.racgp.org.au/afp/2017/june/premature-ovarian-insufficiency-in-general-practic

  Premature ovarian insufficiency (POI), defined as amenorrhoea due to the loss of ovarian function before 40 years of age, can occur spontaneously or be secondary to medical therapies. […] This article examines the diagnostic and management issues when providing care for women with POI in the primary care setting. […] Diagnosis of POI requires follicle-stimulating hormone (FSH) levels in the menopausal range on two occasions, at least four to six weeks apart in a woman aged 40 years after more than four months of amenorrhoea or menstrual irregularity, and after secondary causes of amenorrhoea have been excluded. […] Diagnosis of POI requires FSH levels in the menopausal range on two occasions at least four to six weeks apart in a woman aged 40 years after more than four months of amenorrhoea or menstrual irregularity, and after secondary causes of amenorrhoea have been excluded.

• #3 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  The guideline group recommends that health care professionals (HCPs) enquire about symptoms of estrogen deficiency in women presenting with irregular menstrual cycles or amenorrhea. […] The guideline group recommends HCPs consider and exclude the diagnosis of POI in women aged less than 40 years who have amenorrhea/ irregular menstrual cycles or estrogen-deficiency symptoms. […] HCPs should diagnose POI based on the presence of spontaneous amenorrhea or irregular menstrual cycles and biochemical confirmation. […] The guideline group recommends the following diagnostic criteria: disordered menstrual cycles (spontaneous amenorrhea or irregular menstrual cycles) for at least 4 months, and an elevated follicle stimulating hormone (FSH) concentration25 IU/l. […] FSH assessment should be repeated after 4-6 weeks if there is diagnostic uncertainty.

• #3 Primary Ovarian Insufficiency: Time to Diagnosis and a Review of Current Literature

  https://www.imrpress.com/journal/CEOG/49/6/10.31083/j.ceog4906129

  Background: Prompt recognition of symptoms and subsequent diagnosis of primary ovarian insufficiency (POI) are critical given its consequences on quality of life and long-term health. […] Our study demonstrates a need for more aggressive evaluation of oligo/amenorrhea in underrepresented minority women. Prolonged time to diagnosis of POI has adverse effects, as reflected by hypoestrogenic symptoms and decreased bone mineral density. Delayed diagnosis and management of POI may be related to health care disparities facing these women and warrants action to improve access to care.

• #3 Ovarian Insufficiency Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/271046-workup

  A parallel test of serum estradiol is necessary. As a rule, serum estradiol is low in women with POI/POF and is similar to or less than the early follicular phase estradiol of women who cycle normally. The combination of low estradiol and high gonadotropins defines POI/POF. […] Occasionally, women with POI/POF may have spontaneous follicular activity, and, if hormonal tests are performed during such episodes, levels of FSH, LH, and estradiol could be in the normal range or FSH and LH could be elevated only minimally (below the menopausal range). This may lead to an erroneous rejection of the diagnosis of POI/POF. In these cases, persistent amenorrhea or oligomenorrhea accompanied by menopausal symptoms necessitates a repeat of the above tests in 1-2 months. […] A karyotype should be performed as a part of the routine evaluation after the diagnosis of POI/POF is established. […] Ovarian ultrasonography can be useful in the workup of patients with POI/POF as it will identify those women with multifollicular ovaries and suggest the diagnosis of either autoimmune oophoritis or 17-20 desmolase deficiency.

• #3 Primary Ovarian Insufficiency | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816949/all/Primary_Ovarian_Insufficiency?q=Hyperprolactinemia

  Primary ovarian insufficiency (POI) is used to describe a spectrum of conditions including hypergonadotropic hypogonadism, premature ovarian failure (POF), and ovarian dysgenesis in women 40 years of age. […] Diagnosis is made by two follicle-stimulating hormone (FSH) levels in the menopausal range at least 1 month apart in the setting of 4 to 6 months of menstrual irregularity (3). […] No effective prevention strategies have been identified; however, early diagnosis is key to prevent sequelae.

• #3 Amenorrhea: A Systematic Approach to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0701/p39.html

  Hormone replacement therapy (HRT) may reduce associated vasomotor symptoms, bone mineral density loss, and cardiovascular risk and should be continued until the age of natural menopause (50 to 51 years). A common post-pubertal regimen of HRT is 100 mcg of daily transdermal estradiol or 0.625 mg of daily oral conjugated estrogens, adding 200 mg of micronized oral progesterone daily for 12 days each month. […] Approximately 10% of females diagnosed with primary ovarian insufficiency retain fertility. HRT may not adequately suppress ovulation; therefore, barrier or intrauterine contraceptives may augment HRT for contraceptive purposes. Combined hormonal contraceptives may be substituted for HRT to adequately prevent pregnancy and provide the noncontraceptive benefits of HRT; this approach requires higher doses of estrogen, which may confer additional venous thromboembolic risk. […] A primary ovarian insufficiency diagnosis introduces long-term challenges for patients and families. Clinicians should offer ample time, sensitivity, and emotional support to the patient.

• #3 Correct Dx Key to Primary Ovarian Insufficiency | MDedge

  https://blogs.the-hospitalist.org/content/correct-dx-key-primary-ovarian-insufficiency

  Once you make the diagnosis, use a family systems approach to counseling, Dr. Nelson said. […] Inform both parents and the patient with sensitivity, Dr. Nelson said. Use accurate terminology, provide information, and make appropriate psychosocial referrals. […] After diagnosis and counseling, treatment considerations are next. Unlike postmenopausal women, it’s full hormone replacement for these [girls], he said. […] Although common, follicular depletion associated with POI cannot be proven definitively. It is now clear the ovarian failure is not permanent in all women, Dr. Nelson said. Rarely, some women get pregnant with this diagnosis.

• #3 Primary ovarian failure and its diagnosis using mass sequencing techniques

  https://www.institutobernabeu.com/en/blog/primary-ovarian-failure-and-its-diagnosis-using-mass-sequencing-techniques/

  Primary ovarian failure (POF) or early menopause is the loss of ovarian function before the age of 40. […] In the Instituto Bernabeus Department of Molecular and Genetic Biology we have carried out a project to identify new mutations and genes in patients with familiar ovarian failure. As a result of this study, we have developed a new test to diagnose POF using mass sequencing techniques. This way, we simultaneously study 512 genes that cause this pathology. […] Currently, thanks to this new technology we can carry out a more complete diagnosis, not only from a clinical point of view, but also genetically. […] A correct diagnosis of FOF has great benefits for the patient: Know the origin of your infertility problem. […] Optimize your assisted reproduction treatment.

• #3 Recommendations Updated on Diagnosis, Management of Premature/Primary Ovarian Insufficiency

  https://www.endocrinologyadvisor.com/news/recommendations-updated-on-diagnosis-management-of-premature-primary-ovarian-insufficiency/

  Significant changes from previous guideline include recommendation that only FSH 25 IU required for POI diagnosis. […] The updated guidelines included 145 recommendations. […] Significant changes from the previous guideline include the recommendation that only follicle stimulating hormone (FSH) 25 IU is required for POI diagnosis and guidance that AMH testing, repeat FSH measurement, and/or AMH may be necessary in cases of diagnostic uncertainty. […] The guideline group concluded that there is still an urgent need for more research on the most appropriate diagnostic and treatment options.

• #3 Premature ovarian insufficiency and infertility

  https://www1.racgp.org.au/ajgp/2023/january-february/premature-ovarian-insufficiency-and-infertility

  Premature ovarian insufficiency (POI) is the loss of ovarian function before the age of 40 years and can be spontaneous or iatrogenic. It is an important cause of infertility, and the diagnosis should be considered in any woman presenting with oligo/amenorrhoea, even in the absence of menopausal symptoms such as hot flushes. […] Diagnostic criteria for POI are follicle-stimulating hormone levels 25 IU/L on two occasions at least one month apart following 46 months of oligo/amenorrhoea, with exclusion of secondary causes of amenorrhoea. […] A diagnosis of POI should be considered in any woman under 40 years presenting with oligo/amenorrhoea. […] The diagnosis is often delayed as women or their clinicians do not consider POI as a potential cause of oligo/amenorrhoea. […] The diagnosis of POI can be unexpected and devastating for women and needs to be communicated in a sensitive manner.

• #3 Premature ovarian insufficiency and infertility

  https://www1.racgp.org.au/ajgp/2023/january-february/premature-ovarian-insufficiency-and-infertility

  Once the diagnosis is made, a comprehensive assessment should be undertaken. This includes evaluation for a cause and assessment of overall health, including bone health, cardiovascular disease prevention, fertility issues and psychological health. […] Individualised HRT should be instituted promptly and continued until the usual age of menopause. […] Women at risk of POI should be referred for counselling and potential fertility preservation via oocyte or ovarian cryopreservation. […] For most women with POI, oocyte or embryo donor conception is required for pregnancy.

• #4 Primary Ovarian Insufficiency – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/menstrual-abnormalities/primary-ovarian-insufficiency

  In primary ovarian insufficiency, ovaries do not regularly release eggs and do not produce enough sex hormones despite high levels of circulating gonadotropins (especially follicle-stimulating hormone [FSH]) in women 40. Diagnosis is by measuring FSH and estradiol levels. […] Primary ovarian insufficiency is suspected in women 40 with unexplained infertility, menstrual abnormalities, or symptoms of estrogen deficiency (1). […] A pregnancy test is done, and serum FSH and estradiol levels are measured weekly for 2 to 4 weeks; if FSH levels are high ( 20 mIU/mL, but usually 30 mIU/mL) and estradiol levels are low (usually 20 pg/mL), ovarian insufficiency is confirmed. […] Confirm the diagnosis by measuring FSH (which is high, usually 30 mIU/mL) and estradiol (which is low, usually […] Measure the antimllerian hormone level to help predict which women may respond poorly to infertility treatments.

• #4 Understanding test results for Premature Ovarian Insufficiency

  https://www.daisynetwork.org/understanding-test-results-for-premature-ovarian-insufficiency/

  The remaining tests are specialist ones and are more likely to be performed by a hospital gynaecologist. […] Antibody test There are many causes of POI and it can occasionally be associated with an autoimmune disease (although the cause usually remains unknown or idiopathic). […] AMH AMH stands for anti-Mllerian hormone. This is a relatively new test. At the moment it is used to check a womans ovarian reserve but currently, it can only be interpreted if a woman does not have POI. […] Furthermore, and unfortunately, it cannot be used to predict POI. […] Karyotype and FMR1 gene test A karyotype test counts the number of chromosomes and also checks if any of the chromosomes are mixed up. The most common diagnosis that can be picked up on a karyotype test in POI is Turner syndrome. […] A genetic test can look for abnormalities in the FMR1 gene, which is associated with POI.

• #4 Primary Ovarian Insufficiency | GLOWM

  https://www.glowm.com/section-view/heading/Primary%20Ovarian%20Insufficiency/item/755

  Antimullerian hormone (AMH) is currently being evaluated to determine its value in the diagnosis of POI. AMH could become of great importance in assessing the ovarian reserve in women at risk of developing POI, such as women with cancer undergoing chemotherapy, before extensive ovarian surgery, or females with a family history of early menopause. […] Once a diagnosis of POI is established, further testing is indicated to investigate possible etiologies.

• #4 Premature ovarian insufficiency in general practice: Meeting the needs of women

  https://www.racgp.org.au/afp/2017/june/premature-ovarian-insufficiency-in-general-practic

  In a study of Australian women with POI, diagnosis took longer than two years in 23% of women, with at least two clinicians consulted on average. […] Diagnosis of POI requires FSH levels in the menopausal range on two occasions at least four to six weeks apart in a woman aged 40 years after more than four months of amenorrhoea or menstrual irregularity, and after secondary causes of amenorrhoea have been excluded. […] The routine use of anti-Mllerian hormone levels in the diagnosis of POI is not currently recommended as its accuracy is not validated in this setting. […] Following diagnosis, the aetiology of POI and long-term consequences should be evaluated, and specialist referral may be necessary. […] The diagnosis of POI can be extremely distressing for women. […] The diagnosis of POI is often challenging for health practitioners, and traumatic for affected women.

• #4 Recommendations Updated on Diagnosis, Management of Premature/Primary Ovarian Insufficiency

  https://www.endocrinologyadvisor.com/news/recommendations-updated-on-diagnosis-management-of-premature-primary-ovarian-insufficiency/

  Significant changes from previous guideline include recommendation that only FSH 25 IU required for POI diagnosis. […] The updated guidelines included 145 recommendations. […] Significant changes from the previous guideline include the recommendation that only follicle stimulating hormone (FSH) 25 IU is required for POI diagnosis and guidance that AMH testing, repeat FSH measurement, and/or AMH may be necessary in cases of diagnostic uncertainty. […] The guideline group concluded that there is still an urgent need for more research on the most appropriate diagnostic and treatment options.

• #4 Primary Ovarian Insufficiency: Time to Diagnosis and a Review of Current Literature

  https://www.imrpress.com/journal/CEOG/49/6/10.31083/j.ceog4906129

  Background: Prompt recognition of symptoms and subsequent diagnosis of primary ovarian insufficiency (POI) are critical given its consequences on quality of life and long-term health. […] Our study demonstrates a need for more aggressive evaluation of oligo/amenorrhea in underrepresented minority women. Prolonged time to diagnosis of POI has adverse effects, as reflected by hypoestrogenic symptoms and decreased bone mineral density. Delayed diagnosis and management of POI may be related to health care disparities facing these women and warrants action to improve access to care.

• #4 Premature ovarian insufficiency and infertility

  https://www1.racgp.org.au/ajgp/2023/january-february/premature-ovarian-insufficiency-and-infertility

  Once the diagnosis is made, a comprehensive assessment should be undertaken. This includes evaluation for a cause and assessment of overall health, including bone health, cardiovascular disease prevention, fertility issues and psychological health. […] Individualised HRT should be instituted promptly and continued until the usual age of menopause. […] Women at risk of POI should be referred for counselling and potential fertility preservation via oocyte or ovarian cryopreservation. […] For most women with POI, oocyte or embryo donor conception is required for pregnancy.

• #4 Premature ovarian insufficiency and infertility

  https://www1.racgp.org.au/ajgp/2023/january-february/premature-ovarian-insufficiency-and-infertility

  Premature ovarian insufficiency (POI) is the loss of ovarian function before the age of 40 years and can be spontaneous or iatrogenic. It is an important cause of infertility, and the diagnosis should be considered in any woman presenting with oligo/amenorrhoea, even in the absence of menopausal symptoms such as hot flushes. […] Diagnostic criteria for POI are follicle-stimulating hormone levels 25 IU/L on two occasions at least one month apart following 46 months of oligo/amenorrhoea, with exclusion of secondary causes of amenorrhoea. […] A diagnosis of POI should be considered in any woman under 40 years presenting with oligo/amenorrhoea. […] The diagnosis is often delayed as women or their clinicians do not consider POI as a potential cause of oligo/amenorrhoea. […] The diagnosis of POI can be unexpected and devastating for women and needs to be communicated in a sensitive manner.

• #4 Recommendations Updated on Diagnosis, Management of Premature/Primary Ovarian Insufficiency – Drugs.com MedNews

  https://www.drugs.com/news/recommendations-updated-diagnosis-management-premature-primary-ovarian-insufficiency-122890.html

  Recommendations Updated on Diagnosis, Management of Premature/Primary Ovarian Insufficiency. […] updated recommendations are presented for the diagnosis and management of premature/primary ovarian insufficiency (POI). […] guidelines relating to diagnosis and management of POI based on evidence collected from literature searches and assessment. […] The updated guidelines included 145 recommendations. […] the role of anti-Müllerian hormone (AMH) in the diagnosis of POI and fertility preservation. […] only follicle stimulating hormone (FSH) >25 IU is required for POI diagnosis and guidance that AMH testing, repeat FSH measurement, and/or AMH may be necessary in cases of diagnostic uncertainty. […] Recommendations relating to genetic testing, estrogen doses and regimens, use of the combined oral contraceptive, and testosterone therapy were also updated. […] there is still an urgent need for more research on the most appropriate diagnostic and treatment options.

• #4 Recommendations Updated on Diagnosis, Management of Premature/Primary Ovarian Insufficiency – Clinical Advisor

  https://www.clinicaladvisor.com/news/diagnosis-management-of-premature-primary-ovarian-insufficiency/

  The researchers noted that there is still an urgent need for more research on the most appropriate diagnostic and treatment options for POI. […] In an evidence-based guideline issued by the Centre for Research Excellence in Womens Health in Reproductive Life and published online in Climacteric, updated recommendations are presented for the diagnosis and management of premature/primary ovarian insufficiency (POI). […] The updated guidelines included 145 recommendations. The list of clinical questions addressed in this guideline was expanded, including in relation to the role of anti-Mllerian hormone (AMH) in the diagnosis of POI and fertility preservation. […] Significant changes from the previous guideline include the recommendation that only follicle-stimulating hormone (FSH) 25 IU is required for POI diagnosis and guidance that AMH testing, repeat FSH measurement, and/or AMH may be necessary in cases of diagnostic uncertainty.

• #4 Primary Ovarian Insufficiency: Time to Diagnosis and a Review of Current Literature

  https://www.imrpress.com/journal/CEOG/49/6/10.31083/j.ceog4906129/htm

  Diagnostic criteria according to the American College of Obstetrics and Gynecology (ACOG) include amenorrhea or other abnormal bleeding patterns for a minimum of three months, and menopausal levels of FSH at least a month apart in a patient aged less than 40 years. […] A recent review of clinical practice guidelines (CPGs) for early menopause and primary ovarian insufficiency demonstrated that most CPGs are of low to average quality and have significant variation in their recommendations. […] It is critical that obstetrician/gynecologists and other providers of primary care are educated to have a high index of suspicion for POI in women with menstrual irregularities and a low threshold for referral to a reproductive endocrinologist.

• #5 Ovarian Insufficiency Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/271046-workup

  Three groups of tests should be performed when ovarian failure is suspected or has been diagnosed. They include tests that establish the diagnosis of POI/POF, tests that help clarify the etiology, and screening tests for other diseases known to have higher prevalence among women with POI/POF. […] A pregnancy test (urine or beta human chorionic gonadotropin [bhCG] in the blood) should be the first study performed in every woman of reproductive age who presents with amenorrhea. […] Measuring serum FSH level is the core study to establish the diagnosis of POI/POF after pregnancy has been ruled out. By convention, 2 FSH levels in the menopausal range for the specific assay (40 IU/mL by radioimmunoassay), measured at least 1 month apart, are diagnostic of POI/POF. […] Measurement of serum LH is also important. In most cases of spontaneous POI/POF, FSH is higher than LH. If autoimmune oophoritis is present, FSH may be only mildly elevated, sometimes below the cutoff of 40 IU/mL, while LH is markedly elevated.

• #5 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  The guideline group recommends that health care professionals (HCPs) enquire about symptoms of estrogen deficiency in women presenting with irregular menstrual cycles or amenorrhea. […] The guideline group recommends HCPs consider and exclude the diagnosis of POI in women aged less than 40 years who have amenorrhea/ irregular menstrual cycles or estrogen-deficiency symptoms. […] HCPs should diagnose POI based on the presence of spontaneous amenorrhea or irregular menstrual cycles and biochemical confirmation. […] The guideline group recommends the following diagnostic criteria: disordered menstrual cycles (spontaneous amenorrhea or irregular menstrual cycles) for at least 4 months, and an elevated follicle stimulating hormone (FSH) concentration25 IU/l. […] FSH assessment should be repeated after 4-6 weeks if there is diagnostic uncertainty.

• #5 Primary Ovarian Insufficiency: Time to Diagnosis and a Review of Current Literature

  https://www.imrpress.com/journal/CEOG/49/6/10.31083/j.ceog4906129/htm

  Primary ovarian insufficiency (POI) is a condition defined by the loss of normal ovarian function before the age of 40. […] Early diagnosis is imperative to the proper treatment and management of POI, as POI has been linked with other comorbidities including low bone density, depression, and increased risk of cardiovascular disease. […] A substantial delay between presentation of symptoms and the diagnosis of POI is not uncommon—most experiencing about a 5-year delay between symptom onset and diagnosis, and may be attributed to insufficient understanding and awareness regarding the condition, on the part of women as well as their providers. […] Our study demonstrates a need for more aggressive evaluation of oligo/amenorrhea in underrepresented minority women. Prolonged time to diagnosis of POI has adverse effects, as reflected by hypoestrogenic symptoms and decreased bone mineral density.

• #6 Ovarian Insufficiency Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/271046-workup

  A parallel test of serum estradiol is necessary. As a rule, serum estradiol is low in women with POI/POF and is similar to or less than the early follicular phase estradiol of women who cycle normally. The combination of low estradiol and high gonadotropins defines POI/POF. […] Occasionally, women with POI/POF may have spontaneous follicular activity, and, if hormonal tests are performed during such episodes, levels of FSH, LH, and estradiol could be in the normal range or FSH and LH could be elevated only minimally (below the menopausal range). This may lead to an erroneous rejection of the diagnosis of POI/POF. In these cases, persistent amenorrhea or oligomenorrhea accompanied by menopausal symptoms necessitates a repeat of the above tests in 1-2 months. […] A karyotype should be performed as a part of the routine evaluation after the diagnosis of POI/POF is established. […] Ovarian ultrasonography can be useful in the workup of patients with POI/POF as it will identify those women with multifollicular ovaries and suggest the diagnosis of either autoimmune oophoritis or 17-20 desmolase deficiency.

• #6 Recommendations Updated on Diagnosis, Management of Premature/Primary Ovarian Insufficiency

  https://www.endocrinologyadvisor.com/news/recommendations-updated-on-diagnosis-management-of-premature-primary-ovarian-insufficiency/

  Significant changes from previous guideline include recommendation that only FSH 25 IU required for POI diagnosis. […] The updated guidelines included 145 recommendations. […] Significant changes from the previous guideline include the recommendation that only follicle stimulating hormone (FSH) 25 IU is required for POI diagnosis and guidance that AMH testing, repeat FSH measurement, and/or AMH may be necessary in cases of diagnostic uncertainty. […] The guideline group concluded that there is still an urgent need for more research on the most appropriate diagnostic and treatment options.

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